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Adult tension headache treatment
Generally a fairly featureless headache
The pain is typically bilateral, pressing or tightening in quality and of mild to moderate intensity, and it does not worsen with routine physical activity. No more than one of photophobia, phonophobia or mild nausea and neither moderate or severe nausea nor vomiting
Exclusion of other causes of headache (can be done clinically)
A scan is not generally considered necessary.
Featureless headaches can also be caused by structural problems, so keep clinical antennae raised.
a) Consider Aspirin, Paracetamol or an NSAID for the acute treatment of tension-type headache taking into account the person's preference, comorbidities and risk of adverse events.
Do not offer opioids for the acute treatment of tension-type headache.
a) Consider a course of up to 10 sessions of acupuncture over 5-8 weeks for the prophylactic treatment of chronic tension-type headache (not available on NHS)
b) Tricyclics are commonly recommended by neurologists, but there is no robust evidence from randomised clinical trials.
a) Consider the diagnosis of Medication Overuse Headache. Determine whether the patient has been taking simple analgesics (prescribed and/or OTC) on 15 or more days a month, or codeine-containing analgesics, ergot or triptans on 10 or more days a month. If so, these drugs should be stopped (warn patients of temporarily exacerbating headache) and the headache re-assessed 4 weeks later.
b) Consider anxiety/depression and lifestyle factors – these are often important. Treat as necessary.
Generally tension type headache causes little disability and treatment/referral to neurology/headache clinic is not usually required
References: NICE Clinical guideline CG150: Headaches: diagnosis and management of headaches in young people and adults
This guideline has been signed off by Dr Alex Rowe - GP and Clinical Lead for Planned Care South Devon and Torbay CCG.
Author: S Weatherby, Consultant Neurologist, PHNT / Dr G Lenden Clinical lead DRSS Western
Publication date: January 2017